Monday, 21 July 2014

Special Measures – My view

Last
week's announcement that adult social care providers who deliver sub-standard
care face being put into Special Measures from April 2015 proved to be quite a
momentous event for me. I was involved in the announcement (details here), and
it understandably produced a lot of mixed reaction.I'd
like to use this blog post to clarify some of my thoughts around this issue in
more detail. The singularly most important thing to stress in this debate is
that the majority of care is good care. I have written extensively about the
amazing care my father received from many dedicated and caring professionals
(for examples see: 'Continuity is key', 'Sense and simplicity', 'End-of-life care - A very personal story') some of whom are still good friends of my family. The coverage
I have given to the positive aspects of my father's care on D4Dementia and
elsewhere far outweighs coverage of our negative experiences.It
is widely known that adult social care has a poor reputation, badly tainted by
the actions and culture of a minority whose conduct hits the headlines in a way
that the many positive stories of wonderful care never do. Yet, as I said in my
statement in the press briefing for the Special Measures announcement, "Most
care is excellent. Most care workers are dedicated, and often undervalued,
professionals". I
am the first to acknowledge that there are huge issues in the recruitment and
retention of good care workers (see this blog post), and that the terms and conditions that
many work under fall well short of the professional standing and associated remuneration
that I would like to see given to care work. But none of this is an excuse for
poor care. Many good care workers have terms and conditions of employment that
do not fairly reflect the work that they do and yet they still deliver great
care, and of course the many volunteers who help to prop up services earn
nothing at all and often make an amazing contribution to the lives of
vulnerable adults. None
of that in any way belittles the issues around employment of care workers, but
aligning debates about employment with debates around poor care almost gives
the impression that unfair employment conditions are an excuse for poor care,
when there can never be an excuse for poor care. I know for a fact that the
many wonderful people who cared for my dad weren't paid enough, or valued by
their employers as they should have been (one of my dad's care homes had 4 different owners in the time he lived there), but they were fundamentally dedicated
and caring people who did amazing work in often very difficult
circumstances.In
terms of the proposals about Special Measures, many people have asked me what
will be the difference between Special Measures and the powers CQC have now to issue warning notices
and if necessary take action to remove the registration of a provider and close
a service. To clarify, CQC have been asked to develop a
Special Measures regime for adult social care by the Secretary of State. That process will begin
in autumn 2014 and be done via the Adult Social Care Co-Production group that I am a member of. At present, the in depth details of what Special Measures in
adult social care will look like are still to be decided on.In
the meantime, I have my own personal 'wish list' that draws on the
experience of poor care that we had in the last 6 months of my dad's life. This list includes:1)
Timely intervention - Often vulnerable people don't have weeks and months to
wait for improvements to happen. If the 'care' they are receiving is acutely
failing, it could cause serious injury or premature death.2)
Targeted intervention - A Special Measures style intervention should, in my
view, directly address particular concerns by signposting to resources that can
make an immediate difference to the lives of the people receiving a care
service. There are loads of great resources available, and accessing them
doesn’t necessarily require a provider to spend a lot of money. We are very
fortunate in the UK to have The Social Care Institute for Excellence and
Skills for Care alongside many other innovative and highly effective
national and local organisations, businesses, charities and community interest companies
that can provide guidance, practical resources and be catalysts for change.
Indeed, independent of regulation some care providers work with me in a
consultancy capacity to evaluate, improve or change aspects of their service,
so there are many proactive and forward-thinking providers out there already.3)
Sensitive intervention - It is vital to be mindful that a care home is the home
of the people that live there. In my view Special Measures must do everything
possible to turn a service around in a timely and targeted way without the
people that live there having to find a new care home, unless of course those
people want to find new care home. Having to move can be very distressing, and
again possibly hasten a person's death is they are particularly frail or have
advanced dementia.4)
Public accountability - I hope that, like with hospitals, Special Measures will
provide clarity for families about the status of a service. Families aren't
stupid - they know when care isn't good enough, but generally they are often
too afraid to speak up. They need to see CQC taking firm but fair action that
addresses shortcomings if a service isn’t safe, caring, effective, responsive
and well-led. As part of that process, I would like to see all providers
actively working with families in a renewed effort towards teamwork and
inclusivity in the day-to-day life of a care home.So
how are care providers likely to react? In my view, if you are a good care
provider you have nothing to fear. If you are a provider who is found to have a
service that is delivering sub-standard care but you are prepared to work hard
on turning that service around you have nothing to fear. If, however, you are a
provider of a sub-standard care service and you are complacent and
disinterested in improvement then you are a danger to the people who rely on
you (people receiving your care, their families and any good care workers that
you employ), and anyone who may come into contact with your service in the
future. It is then the role of CQC to take action and it would be indefensible
if they didn't.There
is some disquiet that putting a service into Special Measures will mean that
the provider cannot maintain their revenue stream if one of the conditions of
Special Measures is to prevent the provider from having new admissions to their
care home or new clients to their homecare service. This, however, isn't new - there
was a period when one of my dad's care homes was closed to new admissions due to
safeguarding. In my view this actually helps providers; it enables them to
focus on their service and the improvements that are needed without the added
responsibility of caring for more people, and it safeguards the public from anyone
else coming to harm whilst the service implements improvements.Is
privatising care the reason poor care exists? In my view poor care can occur whether the provider
is making a profit, is a not-for-profit or indeed is a public sector organisation.
The causes of poor care practices are, more often than not, centred around the
culture of an organisation, its leadership and in some cases individual staff
teams or members. Can hospital-style Special Measures work in social care? No,
because clearly there are significant differences between hospitals and social
care, but there are certainly some positive examples of hospitals turning
themselves around as a result of being placed into Special Measures.Can
CQC be trusted with this? As is well known, CQC didn't provide us as a family with the support we needed when my father was alive, but arguing about the
regulator isn't going to change the fact that they are still the regulator. Working
with them to improve social care, celebrating the outstanding examples of care
and uncovering inadequate care is the only option in terms of the regulation of UK
health and social care services. As I have said in the past, inspection -
however rigorous and informed with intelligent monitoring - will still only be
a snapshot of a service. Whistleblowing is as vital now as it has ever been,
whether you are a person receiving care, a family member or a social care
worker.I
believe as a country we owe it to every person who needs social care and their
family to ensure that care is the very best it can be. I will always champion
that regardless of who is in government and who the regulator is. I feel
passionately that we must be the change we want to see, and constantly strive
for improvement and the eradication of poor practice.

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About Me

I'm a campaigner and consultant, writer and blogger. My dad had vascular dementia for approximately the last 19 years of his life. I aim to provide support and advice to those faced with similar situations, inform and educate care professionals and the wider population, promote debate and create improvements in dementia care.